Introduction

The antigens of ABO blood group system (A, B and H) are present on the surface of Red Blood Cells. These antigens are mainly polysaccharide and protein in nature.1 According to International Society of Blood Transfusion (ISBT), there are more than 40 blood group systems including ABO and Rh blood group system. Among all blood group systems, ABO and Rh blood group system is the most important system among all systems. 2 The clinical significance of the ABO blood group system extends beyond routine immunohematology and serology. Several studies have suggested an important association between blood group type and risk of development of cardiovascular, oncological and other diseases.3, 4 According to a hypothesis presence of genetically determined ABO blood group antigen may block binding of causative organism to the cell surface. Risk to a variety of transfusion transmitted infections (TTI) can be associated with blood group type.5 Various studies have been done regarding association of ABO and Rh blood group and TTI; but due to different methods adopted, difference in sample size, social factor and geographic locations, the results obtained were conflicting. Hence, present study was conducted with an aim to determine the distribution of TTI in different ABO and Rh blood groups and for determining the association of TTI with specific blood group type.

Materials and Methods

This is a retrospective study which was conducted at Prathama blood centre, Ahmadabad for a period of five year from January 2016 to December 2020. During this period were 1,43,687 donors donated blood voluntarily. All the information of donors like personal details, demographic details, occupation details and medical history including risk factor, history of previous surgery, hospitalization, blood transfusion were obtained from blood bank software records. Blood grouping was done by Fully automated system from Immucor NEO Gamma (NEO, Immucor Inc.) and QWALYS Diagast EVO (Diagast, France). Both forward grouping (cell grouping) and reverse grouping (serum grouping) were done. Final group was confirmed only when both cell type and serum type was identical. Weak D technique by gel card method was used to confirm Rh negative status of donor. All weak D groups were considered Rh positive. And all the unit were screened for antibody screening by Fully automated Immucor (NEO) and QWALYS Diagast EVO using commercial pooled O cells. As per D & C Act, all the units were screened for the five mandatory TTIs like HIV I & II, HbsAg, HCV, syphilis and malaria. Tests for Hepatitis B Surface antigen (HbsAg), anti-HIV antibody and anti-HCV antibody were done by Enzyme Linked Immuno Sorbent Assay by BIO-RAD (ELISA) test. Syphilis was tested by TPHA method by BIO-RAD and Omega and rapid by aspen card method. Malaria was tested by rapid by Fast Vue card method (Micro-gene diagnostic systems (P) Ltd.). Any sample found reactive was retested with other kit which works on different principle for confirmation. Analysis was done correlating seropositive units with the blood group of the donor.

Results

In the present study, a total of 143,687 healthy donors were screened out of which 138,049 (96.076%) were males and 5638 (3.924%) were females. The overall seropositivity for TTI (HBV, HCV, Syphilis and HIV) among Voluntary donors is 0.58%. Most common Transfusion Transmitted Infection is HBV with a seropositivity of 0.31% (448/1,43,687) while seropositivity is lowest for HCV 0.036% (52/1,43,687) in all the donors. No donor is found to be positive for Malaria during the study period.

Among all groups, seropositivity for TTI is slightly more in B positive blood group (0.19%) while its significantly low in AB negative (0.0035%) blood groups [Table 1]. It was observed that HBV infection is more prevalent in AB negative (0.41%) and significantly less in O negative (0.20%) blood group [Table 3]. HCV positivity is more prevalent in O positive (0.05%) and not observed with A, AB and O negative (0.00%) blood groups [Table 4]. Prevalence for VDRL is significantly more in B negative (0.33%) and less in O positive (0.16%) blood groups [Table 5]. Seropositivity for HIV infection among B positive and negative (0.07%) is more, prevalence was absent in A negative and AB negative (0.00%) blood groups [Table 6]. Seropositivity for all TTI is significantly less in Rh negative blood groups (0.04%) [Table 6].

Discussion

Strict and precise screening of donors for transfusion transmissible infections is performed by all blood centres to ensure safe supply of blood and blood.6 It was observed by Das S et al that frequency of HBsAg antigen and anti-HCV among blood donors had maximum association with blood group O positive but not statistically significant. However highly significant difference was observed for anti-HCV with RhD positive and RhD negative blood group types by Das S et al.7 It was observed that RhD negative blood group donors and RhD positive group donors has almost equivalent prevalence rates of HBsAg but HBsAg is more prevalent in blood group B donors and less prevalent in AB blood group donors. In the present study HBsAg is more prevalent in RhD negative blood group AB donors and observed least in RhD negative blood group O. Many similar studies have observed that blood group B and O positive has higher seroprevalence of HBsAg, anti HCV, HIV and VDRL.8, 9, 10, 11 Tyagi S et al have observed that the negative blood groups are more disposed to TTIs and blood Group A negative donors are more affected with HIV, HBsAg and VDRL while blood Group B negative was more commonly affected by HCV.12 Similarly in present study RhD Positive blood donors (55/134044) had higher percentage of sero-reactivity than RhD negative blood donors (784/9643). Observed that 0.05% and 0.04% of O and AB Rh D-positive and 0.03% of A Rh D-positive and B Rh D-Positive and negative are HCV-positive.13 Jeremiah et al. observed that 25%, 10% and 4.1% of the AB positive, A positive and O positive respectively are HCV-positive.13 In present study, HBsAg was predominantly observed in Rh D negative blood group AB donors, anti-HCV in Rh D positive blood group O and absent in A, AB and O Rh D negative groups, VDRL in Rh D negative blood group B and HIV was sero-reactivity both in Rh D negative and positive blood group B and not observed in A and AB Rh D negative groups. Observed that there is no evidence of any association between seropositivity for syphilis and ABO blood groups.14 Sero-reactivity of these TTI shows that routine screening is a must for blood and blood product for safe transfusion.

Conclusion

The results of the present study show that TTI are more commonly associated with Rh positive blood groups. Blood group B positive showed highest seropositivity for TTI. Blood group AB negative showed lowest seropositivity for TTI and shows less number of seropositivity for HCV and HIV in Rh negative blood groups.

Source of Funding

None.

Conflicts of Interest

There is no conflict of interest.